How mothers talk to their children about failure, mistakes and setbacks is related to their children's fear of failure.

BACKGROUND: Many people fear failure and making mistakes. This fear can be transmitted from parents to children, suggesting that parental communication regarding failures and setbacks may play a critical role in shaping a child's perception of mistakes. AIMS: In this study, we investigated how everyday parent-child conversations about setbacks influence children's fear of making mistakes. SAMPLE: Drawing on the large pre-birth Growing Up in New Zealand cohort, we focused on a sub-sample of 231 mother-child dyads who engaged in a recorded conversations about a "recent disappointment or setback" when the children were 8 years old. METHOD: Conversations between mothers and children about the recent disappointments were coded to identify whether parents recognised or acknowledge their child's emotional response, if action plans were discussed, and the types of resources that the child could draw on. The children also completed a questionnaire about their global self-worth and their fear of making mistakes. RESULTS AND CONCLUSIONS: The discussion of clear action plans, in the absence of a discussion about collaborative resources, was found to be associated with an increased fear of making mistakes among children. Conversely, when mothers clearly acknowledged their child's emotions and discussed ways to work collaboratively with their child on future problems, there was a notable decrease in the child's fear of mistakes. However, it is noteworthy that many mothers in our study either minimally acknowledged or dismissed their child's emotions(40%), rarely discussed action plans (55%), or collaborative resources (79%)when discussing the recent setback.

From infancy to eight: How early maternal mental health, emotion reminiscing, and language shape children's mental health.

To test the transmission of mental health difficulties from mother to child, we examined mediation through emotion reminiscing conversations and child language. Maternal depression symptoms were measured at 9 months post-partum, and child mental health outcomes were measured at age 8 years. Emotion reminiscing conversations between 1,234 mother-child pairs (624 boys, 610 girls) were recorded as part of a large, diverse, longitudinal cohort Growing Up in New Zealand. The 1,234 reminiscing conversations were transcribed and coded for maternal elaboration and emotion resolution quality (mother and child). The coded reminiscing variables did not mediate the pathway from maternal depression to child mental health outcomes; however, each maternal reminiscing variable together with child language skill serially mediated the relationship from maternal depression symptoms to child-reported anxiety and depression symptoms, and parent-reported child externalizing symptoms. Language as a skill and it's use as a tool for making shared meaning from past events are highlighted as possible mechanisms for the intergenerational transmission of mental health difficulties. These findings point to potential opportunities for early interventions, including prevention of and support for postnatal depression, family intervention in reminiscing training, and supporting child language development.

A qualitative examination of the reintegration experiences of Australian Defense Force families.

The profound development that occurs during the first five years of a child's life may contribute to military families with young children facing unique challenges during reintegration. Yet, little is known about the reintegration experiences of military families with young children, and less so from the perspectives of non-deployed parents and families outside of the US. In this qualitative study, we explored the reintegration experiences of Australian Defense Force (ADF) families with young children (five years and younger). Through written responses to open-ended prompts, ADF service members (n = 9) and their non-deployed spouses (n = 38) reflected on periods of reintegration and discussed their family's adaption during this time. Using thematic analysis, six themes representing the reintegration experiences of these families were generated from the data. Four themes were generated from the combined experiences of service members and non-deployed parents, while a further two themes were generated from the experiences of non-deployed parents only. Relational and parenting challenges were at the forefront of reintegration experiences. These findings offer meaningful implications for practice and research to improve the quality of parent-child relationships and enhance outcomes for military families with young children during reintegration.

Maternal depressive symptoms and child language development: Exploring potential pathways through observed and self-reported mother-child verbal interactions.

Maternal depressive symptoms (MDS) in the postnatal period may impact children's later development through poorer quality parent-child interactions. The current study tested a specific pathway from MDS (child age 9 months) to child receptive vocabulary (4 ½ years) through both self-reported and observed parent-child verbal interactions (at both 2 and 4 ½ years). Participants (n = 4,432) were part of a large, diverse, contemporary pre-birth national cohort study: Growing Up in New Zealand. Results indicated a direct association between greater MDS at 9 months and poorer receptive vocabulary at age 4 ½ years. There was support for an indirect pathway through self-reported parent-child verbal interactions at 2 years and through observed parent-child verbal interactions at 4 ½ years. A moderated mediation effect was also found: the indirect effect of MDS on child vocabulary through observed verbal interaction was supported for families living in areas of greater socioeconomic deprivation. Overall, findings support the potential role of parent-child verbal interactions as a mechanism for the influence of MDS on later child language development. This pathway may be particularly important for families experiencing socioeconomic adversity, suggesting that effective and appropriate supportive parenting interventions be preferentially targeted to reduce inequities in child language outcomes.

Maternal reminiscing during middle childhood: Associations with maternal personality and child temperament from the Growing Up in New Zealand cohort study.

The way that mothers talk about the past (reminisce) with young children is linked to key memory, language, and socioemotional outcomes. The present research explored the role of a range of child, maternal, socioeconomic, and cultural factors that predict maternal reminiscing style, with a particular focus on maternal personality and child temperament. A total of 1,404 mother-child dyads from the prebirth longitudinal cohort study Growing Up in New Zealand (https://www.growingup.co.nz) participated in a reminiscing task about a negative event when children were 8 years old. This broader cohort is broadly representative of the New Zealand population in terms of maternal ethnicity and socioeconomic status. Conversations were scored using a revised version of the Elaborative Reminiscing Scale. Child temperament during infancy, but not childhood, uniquely predicted maternal reminiscing style. Maternal extraversion also predicted a more elaborative reminiscing style. Other maternal factors, including education, ethnicity, and age, were also identified as unique predictors of maternal reminiscing style. These findings fit well with an ecological systems view of maternal reminiscing as a function of child, maternal, and cultural factors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mind-mindedness and preschool children's behavioral difficulties: The moderating role of maternal parenting distress.

Mind-mindedness (MM) is a caregiver's tendency to appreciate their infant's internal mental states. This longitudinal study investigated whether maternal MM (10 months) was linked with children's later behavioral problems (51 months) and the moderating role of maternal parenting distress (PD; 36 months) in a sample of 91 mother-infant dyads. Appropriate MM comments were coded from video-recorded, semi-structured play interactions between mothers and their infants; PD was obtained from maternal completion of the PD subscale of the Parenting Stress Index - Short Form (PSI-SF); and child internalizing and externalizing behavior problems were gathered from maternal report on the Strengths and Difficulties Questionnaire (SDQ). Moderated regression analyses revealed higher early appropriate MM was associated with significantly fewer internalizing emotional problems at 51 months among mothers with lower PD at 36 months, and higher early appropriate MM was associated with lower conduct problems at 51 months in mothers with higher PD at 36 months. Findings demonstrated the importance of considering nuanced contexts such as at-risk mothers and differential presentations of child difficulties in the analysis of the relationship between MM and child behavioral difficulties and the development of MM interventions.

Fathers' help seeking behavior and attitudes during their transition to parenthood.

New fathers face multiple changes as they take on this complex, demanding, and continually shifting role. The current study aimed to understand these experiences, especially the ways fathers seek help and information while facing stressful situations. Eleven fathers completed a semi-structured interview about their transition to fatherhood and whether and how they sought help and advice through that process. Results were analyzed using an inductive thematic analysis approach. Fathers viewed themselves as supportive figures and sources of financial and emotional stability for their families. Fathers experienced anxiety and uncertainty in their transition to parenthood, and utilized a variety of ways to cope with their stress; these were categorized into individual and interpersonal coping strategies. Most relied on their partner for emotional support, but some felt uncomfortable relying on her and using her for support while she was coping with pregnancy and new parenting. This study found that fathers tended to see themselves in a rather traditional role of provider and supporter of their partners and children, and this created some stresses for work-life balance, and, for some, created a dilemma where they felt unable to seek emotional support from the person-their partner-on whom they would typically rely. These findings have important implications for fathers' wellbeing and providing support programs for new fathers.

Papás novatos enfrentan múltiples retos a medida que asumen este papel complejo y exigente. Poco se sabe acerca de cómo los papás experimentan estos retos. Este estudio se propuso comprender estas experiencias, especialmente la manera como los papás buscan ayuda e información mientras que enfrentan situaciones estresantes. Once papás completaron una entrevista semiestructurada acerca de la transición a la paternidad y cómo buscaron ayuda a través de ese proceso. Los resultados se analizaron usando un análisis temático inductivo. Los papás se vieron a sí mismos como figuras de apoyo y fuentes de estabilidad económica y emocional para sus familias. Los papás experimentaron ansiedad en la transición a la paternidad y utilizaron diferentes maneras para arreglárselas con el estrés; estas maneras fueron categorizadas en estrategias individuales e interpersonales para arreglárselas. La mayoría confió en sus parejas para apoyo emocional, pero algunos se sintieron incómodos confiando en ella para ese apoyo mientras que ella se las arreglaba con el embarazo y la nueva crianza. En este estudio se encontró que los papás tendían a verse a sí mismos en un papel tradicional de proveer y de apoyar a sus familias, y esto produjo cierto estrés para equilibrar la vida laboral, así como un dilema en los casos en que se sintieron incapaces de buscar el apoyo emocional de sus parejas en quienes ellos confiaban típicamente. Estos resultados tienen implicaciones importantes para el bienestar de los papás y proveer programas de apoyo para los nuevos papás.

Les nouveaux pères font face à de nombreux défis quand ils embrassent ce rôle complexe et difficile. On sait peu de choses sur la façon dont les pères vivent ces défis. Cette étude s'est donné pour but de comprendre ces expériences, surtout les manières dont les pères cherchent de l'aide et des renseignements tout en faisant face à des situations stressantes. Onze pères ont rempli un entretien semi-structuré sur leur transition la paternité et la manière dont ils ont cherché de l'aide au travers de ce processus. Les résultats ont été analysés en utilisant une analyse thématique inductive. Les pères se sont perçus comme des figures de soutien et des sources de stabilité financière et émotionnelle pour leur famille. Les pères ont fait l'expérience d'anxiété dans leur transition à la parentalité et ont utilisé différentes manières de faire face au stress; celles-ci ont été catégorisées en stratégies d'adaptation individuelles et interpersonnelles. La plupart se sont appuyés sur leur partenaire pour le soutien émotionnel, mais certains d'entre eux n'étaient pas l'aise de compter sur elle pour du soutien alors qu'elle faisait face à la grossesse et au nouveau parentage. Cette étude a trouvé que les pères avaient tendance à se voir dans un rôle traditionnel de père pourvoyeur et de soutien pour leur famille et cela déclenchait des stress pour l'équilibre travail-vie de faille, et un dilemme s'est avéré être qu'ils se sentaient incapables de chercher du soutien émotionnel auprès de leur partenaire sur qui ils compteraient typiquement. Ces résultats ont des implications importantes pour le bien-être des pères et la création de programmes de soutien aux nouveaux pères.

The role of pregnancy acceptability in maternal mental health and bonding during pregnancy.

BACKGROUND: Pregnancy is an important time for women's mental health and marks the foundations of the emerging bond between mother and baby. This study aimed to investigate the role of pregnancy acceptability and intendedness in maternal mental health and bonding during pregnancy. METHODS: Data were collected from a community sample of 116 Australian pregnant women (M = 29.54, SD = 5.31) through a series of self-report questionnaires pertaining to mental health and antenatal bonding. RESULTS: Lower pregnancy acceptability was correlated with higher depression, anxiety and total distress, lower physical and environmental quality of life and lower antenatal bonding. Women who reported their pregnancy was intended reported higher physical quality of life than those who reported their pregnancy was unintended. The relationship between total distress and antenatal bonding was moderated by women's degree of pregnancy acceptability (low versus high). For women with low acceptability, higher distress was associated with lower bonding, but there was no such association for women with high pregnancy acceptability. The moderation model examining associations between distress and pregnancy acceptability explained 15% of the variance in antenatal bonding scores. CONCLUSION: Consideration of women's appraisal of their pregnancy acceptability may provide a valuable framework for identifying individuals who may be at risk for mental health and bonding difficulties.

The implications of parent mental health and wellbeing for parent-child attachment: A systematic review.

BACKGROUND: Parent mental health and wellbeing may have implications for understanding attachment transmission. In this systematic review, we synthesise the published literature to determine the nature of the relationship between parent mental health and wellbeing and the intergenerational transmission of attachment and to provide recommendations for future research, clinical practice and intervention. METHOD: Using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach, five electronic databases were searched for peer-reviewed empirical studies, published in English. Articles were considered for inclusion if data was collected on adult attachment, child attachment, and a domain of parent mental health/wellbeing. No date parameters were applied to the search strategy. The review was registered with PROPSERO (registration number: CRD42020157247). RESULTS: Eleven studies examining the impact on parent mental health and wellbeing on the intergenerational transmission of attachment were identified for inclusion in this review. Our review found preliminary evidence that parent mental health and wellbeing play a role in the intergenerational transmission of attachment. Other key findings from the review were: evidence quality is mixed due to variable measurement of attachment and mental health; studies have mostly included correlational analysis or do not utilise contemporary methodological approaches to testing mediating or moderating relationships; and literature is largely focused on psychopathology and negative factors of mental health. CONCLUSIONS: The limited scope of parent mental health and wellbeing constructs examined in the literature, the sparse use of robust statistical analyses, and the lack of literature in general makes it difficult to draw conclusions on how and why parent mental health impacts attachment transmission. Addressing these limitations will further progress attachment-related literature and may have particular implications for attachment-informed interventions with clinical populations.

Physical Conflict During Pregnancy: A Socioecological, Cross-Cultural Examination of Risk and Protective Factors for New Zealand Women.

Participants were 5,831 women in their third trimester of pregnancy, part of a large, longitudinal, pre-birth national cohort study. Women reported on their experience of pushing and shoving, throwing or breaking objects within their relationship over the past month. Univariable regression models examined the association of a large number of potential risk and protective factors. Those significant at the univariable level were carried forward into final multivariable analyses, stratified by New Zealand's four main ethnic groups: European, Maori, Pacific, and Asian peoples. Relationship commitment, reduced family cohesion, and perceived stress were associated with increased risk across ethnic groups.

What factors are associated with early childhood dental caries? A longitudinal study of the Growing Up in New Zealand cohort.

BACKGROUND: The relative importance of different strategies to prevent dental caries is not known. AIM: We explored the relationship between oral health behaviours, diet, and the incidence of dental caries. DESIGN: We conducted a study of children participating in the 'Growing Up in New Zealand' cohort. Exposures were oral health behaviours, a food frequency questionnaire, and sociodemographic characteristics that were recorded when the child was nine months and two years old. Outcomes were records of dental caries at ages four to seven years. RESULTS: 4111 children had dental examination records from between the ages of four and seven years. High levels of dental caries were reported in children of Pacific, Asian, and Maori ethnicity. Food frequency questionnaire information was summarised into two principal components. The major axis of variation was in the intake of food and drinks with high concentrations of sugar and refined starch, with this component strongly associated with caries (multivariable incidence rate ratio of caries 0.48; 95% confidence interval: 0.38-0.61, comparing the extreme quintiles of the first principal component). CONCLUSIONS: A diet high in sugar or refined starch was strongly linked to caries. Policies to reduce sugar and refined starch intake should be considered.

Maternal Antenatal Depression and Early Childhood Sleep: Potential Pathways Through Infant Temperament.

OBJECTIVE: Maternal depression is associated with infant and child sleep patterns, and with infant temperament. Here, we examine whether infant temperament mediated an association between maternal antenatal depression and toddler sleep. METHOD: Within the prebirth longitudinal cohort Growing Up in New Zealand, symptoms of antenatal and postnatal depression were measured in 5,568 women using the Edinburgh Postnatal Depression Scale (EPDS). Infant temperament was measured at age 9 months using the Very Short Form of Infant Behavior Questionnaire-Revised (IBQ-R VSF). Sleep duration and nighttime awakenings were reported by parents when children were 2 years old. RESULTS: Independent associations of maternal depression with child sleep patterns at age 2 years, adjusted for maternal demographics, physical health, family relationships, and child health and feeding, were determined using multivariate logistic regression analysis. The odds of having ≥2 nighttime awakenings were increased for children whose mothers had antenatal (1.36, 1.07-1.73) but not postnatal (1.22, 0.88-1.68) or both antenatal and postnatal depression (0.89, 0.56-1.36). There was no association of maternal depression with shorter sleep duration. Two of five dimensions of infant temperament (fear and negative affect) were associated with both antenatal depression scores and increased nighttime awakenings. Mediation analyses controlling for postnatal depression and other predictors of child sleep supported an indirect pathway of antenatal depression to child sleep through infant temperamental negative affectivity. CONCLUSION: Antenatal depression is independently associated with more frequent nighttime awakenings in early childhood. Findings support an indirect pathway through infant negative affect characteristics.

Identifying Rewards Over Difficulties Buffers the Impact of Time in COVID-19 Lockdown for Parents in Australia.

OBJECTIVE: Physical isolation measures, known as lockdown or shelter-in-place, experienced during coronavirus disease 2019 (COVID-19) have the potential to cause psychological distress. This study was conducted to examine parents' perceived stress and whether reports of rewards and challenges during lockdown impact stress. METHODS: Data were collected using a cross-sectional online survey in New South Wales, Australia, across the 4-week lockdown. The survey was completed by 158 parents of children aged under 6 years. Stress was measured using the short form of the Perceived Stress Scale (PSS-4). Rewards and challenges were reported in response to two open-ended questions. RESULTS: There was a weak negative correlation between PSS-4 scores and days in isolation (r = -0.167, p = 0.022), with parents who had spent longer in isolation reporting fewer stress symptoms. The relationship between time in isolation and stress was moderated by the degree to which parents described more rewards than challenges: parents who perceived high rewards and low challenges reported lower PSS-4 scores with more days in lockdown, whereas parents who perceived low rewards and high challenges reported higher PSS-4 scores with more days in lockdown. The moderation model examining associations between time in isolation and rewards ratio explained 13% of the variance in PSS-4 scores. CONCLUSION: Lockdowns are not uniformly or consistently negative experiences for parents. Identifying positive aspects of the experience may serve to buffer negative mental health risks across time. Understanding resilience strategies is critical for supporting current psychological wellbeing and to adequately prepare for future pandemic experiences.

Antenatal determinants of early childhood talking delay and behavioural difficulties.

The determinants of talking delay alone or its comorbidity with behavioural difficulties was examined in 5768 two-year-old members of the Growing Up in New Zealand longitudinal study. Using the MacArthur-Bates Communicative Development inventories and the total difficulties score from the preschool Strengths and Difficulties Questionnaire, a composite measure was created so that children were categorised as showing no language or behavioural concerns (72.5%), behavioural only difficulties (6.1%), language only difficulties (18.1%), and comorbid language and behavioural difficulties (3.3%). Analyses revealed that antenatal factors such as maternal perceived stress, inadequate folate intake, vitamin intake, alcohol consumption during the first trimester and maternal smoking all had a significant effect on child outcomes. In particular, low multivitamin intake and perceived stress during pregnancy were associated with coexisting language and behavioural difficulties. These findings support international research in showing that maternal factors during pregnancy are associated with developmental outcomes in the early childhood period, and demonstrate these associations within a NZ context. Interventions which address maternal stress management and health behaviours during pregnancy could be beneficial to offspring development.

A primary care programme to improve identification and stepped-care support of Asians with mental health and lifestyle issues.

INTRODUCTION Asians living in Western countries have a higher incidence of mental health and lifestyle issues, but are less likely to disclose these to health-care professionals due to stigma. Instead, they tend to present to primary care with somatic concerns. AIM To assess the feasibility and acceptability of a well-validated electronic screening and stepped-care support tool (eCHAT) to identify mental health and lifestyle issues among Asian patients. METHODS A mixed-methods (interviews and survey) co-design approach explored patient and clinic staff perspectives on a translated version of eCHAT (AsiaCHAT). Recruitment was through a large primary care organisation with a high proportion of Asian patients. Of the 307 approached, 277 participated (92% acceptance rate). RESULTS Problems of depression (n = 12) and anxiety (n = 69) were identified among patients, as were sexual health concerns (n = 22) among younger participants. Overall, participants and clinic staff rated AsiaCHAT as a useful and acceptable tool for disclosing and discussing patient concerns. Problems of finances, time constraints and competing demands made long-term implementation challenging. DISCUSSION AsiaCHAT is a promising tool for identifying mental health and lifestyle concerns among Asians presenting to primary care. The electronic screener supports patient and provider discussion of sensitive topics and the stepped-care support function helps direct care. Its flexible functionality means that there is potential to integrate it into busy clinic settings as well as online patient portals, and the programme aligns with current policy to improve Asian health in New Zealand.

Antenatal depression symptoms in Pacific women: evidence from Growing Up in New Zealand.

INTRODUCTION Pacific women in New Zealand (NZ) have higher rates of antenatal depression than women from other ethnic groups. AIM To identify factors that are significantly associated with depression symptoms in pregnant Pacific women living in NZ. METHODS Data were collected from 5657 pregnant women, 727 of whom identified their ethnicity as Pacific Island. Antenatal depression symptoms were measured using the Edinburgh Depression Scale with scores above 12 indicating elevated antenatal depression symptoms (ADS). RESULTS Pacific women had significantly higher rates of ADS than non-Pacific women, with 23% of pregnant Pacific women experiencing ADS. Factors associated with ADS for Pacific women included age <25 years, moderate to severe nausea during pregnancy, perceived stress, family stress and relationship conflict. Not seeing the importance of maintaining one's Pacific culture and traditions and negative feelings towards NZ culture were also significantly associated with ADS in Pacific women. One in three Pacific women aged <25 years experienced ADS. Pregnant Pacific women without a family general practitioner (GP) before their pregnancy were 4.5-fold more likely to experience ADS than non-Pacific women with a regular GP. DISCUSSION Further attention is required to providing appropriate primary health care for Pacific women of child-bearing age in NZ. Better screening processes and a greater understanding of effective antenatal support for Pacific women is recommended to respond to the multiple risk factors for antenatal depression among Pacific women.

Green Space and Depression during Pregnancy: Results from the Growing Up in New Zealand Study.

Background: Antenatal depression is an important contributor to poor maternal health experienced by some women. This study aimed to determine whether exposure to green space during pregnancy is associated with less depression, and whether this association is moderated by relevant factors, such as age, education, self-identified ethnicity, physical activity, residential rurality, and socioeconomic status. Methods: Health data were sourced from the cohort study "Growing Up in New Zealand" comprised of 6772 participants. Green space was estimated based on the proportion of green space within the Census Area Unit. Adjusted logistic mixed effect models were used to investigate the association between green space and antenatal depression after controlling for confounding variables. Results: Maternal exposure to green space were not associated with lower odds of antenatal depression. Indications of effect modifications due to relevant factors were not observed. Conclusions: This study did not determine an association between access to green space (measured based on the distance to the nearest green space) and antenatal depression. Therefore, a link between green space and antenatal depression was not established. For that reason, ensuring residential areas contain adequate green space may or may not be helpful in preventing antenatal depression and adverse health outcomes associated with this depression. More studies focusing on pregnant women in a range of social contexts, and considering both exposure and access to green space, are warranted to determine the relationships between green space and antenatal depression.

Green space and pregnancy outcomes: Evidence from Growing Up in New Zealand.

OBJECTIVES: To determine whether maternal exposure to green space during pregnancy is associated with birth weight and gestational age, and whether these associations are modified by demographic and residential factors. METHODS: Data describing 5091 mother-newborn pairs with residential address during pregnancy linked to data describing their green space exposure. Independent associations determined using linear mixed effects models. RESULTS: Maternal exposure to green space during pregnancy was not associated with birth weight and gestational age for the entire cohort. For pregnant women who have not acquired secondary school education, increased exposure to green space was associated with increased gestational age. CONCLUSION: The provision of green space might prove to be beneficial in terms of increasing gestational age for pregnant women who have not acquired secondary school education qualifications.

Maternal health in pregnancy and associations with adverse birth outcomes: Evidence from Growing Up in New Zealand.

OBJECTIVE: To examine prospectively multiple indicators of pregnancy health and associations with adverse birth outcomes within a large, diverse sample of contemporary women. DESIGN: A cohort of pregnant women who gave birth during 2009-10. POPULATION: We enrolled a sample of 6822 pregnant New Zealand (NZ) women: 11% of all births in NZ during the recruitment period. METHODS: We analysed a number of maternal health indicators and behaviours during pregnancy in relation to birth outcomes using multivariable logistic regression. Associations were described using adjusted odds ratios and 95% confidence intervals. MAIN OUTCOME MEASURES: Three birth outcomes, low birth weight (LBW), pre-term birth (PTB) and delivery type, were measured via linkage with maternity hospital perinatal databases. Small for gestational age (SGA) was then defined as below the 10th percentile by week of gestation. RESULTS: Modelling of birth outcomes after adjusting for confounders indicated patterns of increased risk of LBW and PTB for women who smoke, have elevated pre-pregnancy body mass index (BMI), or with insufficient pregnancy weight gain. SGA was associated with maternal smoking, alcohol use, insufficient weight gain and nausea and vomiting during pregnancy. Risk of caesarean section was associated with having a diagnosed illness before pregnancy, elevated BMI, greater pregnancy weight gain and less pregnancy exercise. Number of risk factor variables were then used to model birth outcomes. Women with multiple risk factors were at increased risk compared with those who had no risk factors. CONCLUSIONS: Women with multiple health risks are at particular risk of adverse birth outcomes.

Green Space and Physical Activity in Pregnant Women: Evidence From the Growing Up in New Zealand Study.

BACKGROUND: Exposure to green space has been associated with increased physical activity. However, it is not clear whether this association is because active people preferentially live in greener areas. Relationships between exposure to green space and physical activity during pregnancy are not well defined. Our objective was to determine whether exposure to green space was associated with physical activity in pregnant women. METHODS: The current study was completed within the Growing Up in New Zealand cohort study of 6772 pregnant women. The proportion of green space in each census area unit was determined and geocoded to residential address. The association between exposure to green space and physical activity was determined using logistic regression analyses after controlling for confounding variables. RESULTS: Exposure to green space was not associated with participation in physical activity during first trimester and the remainder of pregnancy once preference for living in greener neighborhoods was taken into account. CONCLUSIONS: The lack of association between green space and physical activity found in this study does not necessarily mean that living in green space will not translate into better pregnancy health. Preference for living in greener neighborhoods should be considered when investigating relationships between green space and physical activity.